Reviewing long-term antidepressants can reduce drug burden: a prospective observational cohort study

Background: Antidepressant prescribing continues to rise. Contributing factors are increased long-term prescribing and possibly the use of higher selective serotonin re-uptake inhibitor (SSRI) doses. Aim: To review general practice patients prescribed the same antidepressant long-term (=2 years) and evaluate prescribing and management pre and post-review. Design and setting: Prospective observational cohort study using routine data from 78 urban general practices, Scotland. Method: All patients prescribed antidepressants (excluding amitriptyline) for =2 years were identified from records November 2009 to March 2010. GPs selected patients for face-to-face review of clinical condition and medication, December 2009 to September 2010. Pre- and post-review data were collected; average antidepressant doses and changes in prescribed daily doses were calculated. Onward referral to support services was recorded. Results: 8.6 % (33 312/388 656) of all registered patients were prescribed an antidepressant, 47.1 % (15 689) were defined as long-term users and 2849 (18.2 %) were reviewed. 811 (28.5 %) patients reviewed had a change in antidepressant therapy: 7.0 % stopped, 12.8 % reduced dose, 5.3 % increased dose, and 3.4 % changed antidepressant, resulting in 9.5 % (95 % CI = 9.1 % to 9.8 % P < 0.001) reduction in prescribed daily dose and 8.1 % reduction in prescribing costs. 6.3 % were referred onwards, half to NHS Mental Health Services. Pre-review SSRI doses were 10-30 % higher than previously reported. Conclusion: Almost half of all people prescribed antidepressants were long-term users. Appropriate reductions in prescribing can be achieved by reviewing patients. Higher SSRI doses may be contributing to current antidepressant growth.